Decreasing the use of restraint and seclusion among psychiatric inpatients

We describe a hospital-wide effort to decrease restraint and seclusion of psychiatric inpatients. Our hypotheses were that interventions could reduce the number of patients as well as patient hours in restraint and seclusion, without an increase in adverse outcomes (fights/assaults, staff injuries, and elopements).

This study was performed at an urban academic psychiatric hospital (New York State Psychiatric Institute) with 3 inpatient units totaling 58 beds. Interventions included 1) decreasing initial time in restraint or seclusion from 4 to 2 hours before a new order was required; 2) education of staff concerning identification of patients at risk of restraint or seclusion and early interventions to avoid crises; and 3) use of a coping questionnaire to assess patient preferences for dealing with agitation. Data were assessed 20 months before and 67 months following the implementation of these interventions.

The mean number of patients restrained went from 0.35 +/- 0.6 to 0.32 +/- 0.5 patients/month; mean hours of restraint decreased from 1.7 +/- 5.2 to 1.0 +/- 2.4 hours/month. The mean number of patients secluded decreased significantly from 3.1 +/- 1.4 to 1.0 +/- 1.1 patients/month. The mean hours of seclusion decreased markedly, from 41.6 +/- 52 to 2.7 +/- 4.5 hours/month. Adverse outcomes (elopements and fights/assaults) also decreased significantly over the follow-up period.

Interventions were successful in decreasing use of restraint and seclusion on both clinical and research units over more than 5 years of follow-up. Such interventions may be adapted to other settings.